Healthcare Provider Details

I. General information

NPI: 1295957157
Provider Name (Legal Business Name): CATHY M CLARKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 WEST 114 STREET
NEW YORK NY
10030
US

IV. Provider business mailing address

219 WEST 114 STREET
NEW YORK NY
10030
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-3500
  • Fax: 212-694-4998
Mailing address:
  • Phone: 212-694-3500
  • Fax: 212-694-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: